Glucagon is a hormone that works with other hormones and bodily functions to control glucose levels in the blood. It comes from alpha cells found in the pancreas and is closely related to insulin-secreting beta cells, making it a crucial component that keeps the body’s blood glucose levels stable.
While glucagon keeps blood glucose from dropping too low, insulin is produced to keep blood glucose from rising too high. The two hormones counterbalance each other to stabilize blood glucose. When blood glucose levels fall too low (low blood glucose), the pancreas pumps out more glucagon. This hormone helps blood glucose rise back up in multiple ways:
- It causes the liver to convert stored glucose into a usable form and then release it into the bloodstream. (A process called glycogenolysis.)
- Glucagon also stops the liver from taking in and storing glucose, so more stays in the blood.
- Glucagon helps the body make glucose from other sources, such as amino acids.
When everything is working well, insulin moves glucose out of the blood and into the cells, where it is used for energy. Meanwhile, a complex feedback system within the body lets it know when no more glucagon is needed. In a nutshell, glucagon normally keeps blood glucose from dropping too low. Insulin keeps it from rising too high. The two hormones counterbalance each other.
Potential problems with glucagon function
Glucagon function is crucial to proper blood glucose levels, so problems with glucagon production will lead to problems with glucose levels. Low levels of glucagon are rare but are sometimes seen in babies. The main result is low levels of blood glucose. The treatment is to inject the patient with glucagon. When the individual has recovered sufficiently, eating carbohydrates will then raise the blood glucose levels even more. High levels of glucagon are also rare but can occur when a patient develops a specific type of tumor in the pancreas. Patients with high levels of glucagon can develop diabetes mellitus or experience unexpected weight loss.
Hypoglycemia and Glucagon
A mild case of hypoglycemia may cause shakiness, headache, sweating, clammy skin, or a pounding heartbeat. Blood glucose level falls to 54–69 mg/dL. Mild hypoglycemia can generally be treated by consuming 15 grams of a fast-acting sugar source, such as fruit juice, non-diet soda, hard candies, or glucose tablets. If hypoglycemia becomes severe, you may not be able to safely swallow food or drink. By this point, the blood glucose level is less than 54 mg/dL—often below 40 mg/dL. You may feel very confused, pass out, or have a seizure. Without prompt treatment, severe hypoglycemia may lead to a coma or even death.
Fortunately, severe hypoglycemia in a person with diabetes can be treated with prescription glucagon. Someone else will likely need to administer the glucagon, but this person does not have to be a health care professional. Relatives, friends, coworkers, and others can learn to give glucagon.
Injection Kit: A traditional injection kit contains a vial of powder (glucagon) and a syringe filled with saline (salt water).
Auto-injector Pen: A pre-mixed, ready to use dose of glucagon. It is similar to the EpiPen used to treat serious allergic reactions.
Dry Nasal Spray: A (needle-free) nasal powder form of glucagon. It uses a plunger to spray into the nose, much like a typical nasal spray.
What Happens After a Dose of Glucagon?
If you pass out due to severe hypoglycemia, you will usually regain consciousness within 15 minutes after receiving glucagon. Once you are awake and able to swallow, your helper should give you a fast-acting sugar source. After that, eat a long-acting sugar source, such as crackers and cheese or a sandwich with meat. In addition, call your health care provider right away. Your provider may have additional treatment advice.
If you remain unconscious 15 minutes after receiving glucagon, your helper should administer one more dose of glucagon and call 911. Your helper should also call 911 if you wake up but are still confused.
Side Effects of Emergency Glucagon
Possible side effects of glucagon treatment include:
- Nausea and vomiting
- Headache
- Temporary increase in heart rate
- Redness and swelling at the injection site.
For nasal glucagon, additional side effects may include:
- Runny or stuffy nose
- Red or watery eyes
- Itchy nose, eyes, or throat
If you are struggling with managing blood sugar, or chronic low blood sugar levels, a number of factors could be causing your problem. Talk to your doctor about glucagon and whether or not it could be a factor. Consider asking:
- Which treatments and lifestyle changes can help manage my diabetes?
- Is glucagon impacting my blood sugar levels?
- What can I do to improve glucagon levels?
- What should be my target blood glucose range?
- How can I better control blood sugar levels?
- What can I do to increase my awareness of low blood glucose?
- How can I treat mild hypoglycemia to help keep it from becoming severe?
- Do I need a glucagon prescription? If so, which product is best for my needs?
- Where can people in my support network find training on how to give glucagon?
Medically Reviewed by Brunilda Nazario, MD on July 27, 2020
An insulinoma is a rare tumor of the pancreas. It’s made of cells called beta islet cells, the same ones in the pancreas that make insulin and control your blood sugar. Normally, your pancreas makes more insulin when your blood sugar is high and less when your blood sugar is low. But an insulinoma makes insulin all the time, even when your blood sugar gets too low. You might hear an insulinoma called a "neuroendocrine tumor" because it starts in special cells in your body called neuroendocrine cells. These tumors are usually small (less than an inch), and almost all of them aren’t cancer. In most cases, surgery can cure them. Because insulinomas make too much insulin, they can cause symptoms of low blood sugar, also known as hypoglycemia. You might have: Hypoglycemia can be dangerous. If your blood sugar drops too low, you could faint or go into a coma. Hypoglycemia is common in people with diabetes. It often happens because they took too much of their medicine, missed a meal, or got more exercise than usual, all of which can lower blood sugar. An insulinoma can also cause hypoglycemia when you haven’t eaten in a while, but it can happen at any time. It isn’t clear why some people get insulinomas. Women are slightly more likely to have them than men. Most people get them between ages 40 and 60. You’re also more likely to have an insulinoma if you have certain genetic conditions, including:
It can be tough for doctors to diagnose an insulinoma. Its symptoms are the same as those of other common health problems. It may take time before your doctor can find it. You’ll get tests like: Blood tests and suppression tests. To find out if you have an insulinoma, your doctor will test your blood sugar, insulin, C-peptide, and proinsulin during a 72-hour rest. This will confirm that: To do that, they’ll watch what happens to your blood sugar after you fast for a day or two. You may need to stay in the hospital during this time, and you won’t be able to eat or drink anything except water. The doctor will test your blood to see if you have both low blood sugar and a high insulin level. Imaging tests. You may also get an imaging test such as a CT scan, ultrasound, or MRI so your doctor can see where the tumor is. The main treatment for an insulinoma is surgery to remove the tumor. Most of the time, that will cure you.
The type of surgery you get depends on the type, size, and location of the tumor. Surgeons can usually remove just the insulinoma from the surface of your pancreas. Other times, the surgeon may need to remove part of the pancreas connected to the tumor. But this is less common.
You might be able to have laparoscopic surgery to remove an insulinoma. In this operation, doctors make several smaller cuts in your body instead of one large one. They use special instruments to do the surgery. That means you’ll have less pain as you heal, stay fewer days in the hospital, and can return to normal life more quickly.
Most people won’t need any more treatment after surgery.
If your doctor thinks surgery won’t work for you, you can try other treatments to manage low blood sugar. You might take medicine and eat smaller meals more often throughout the day.
Treatment for cancerous insulinomas Cancerous insulinomas are rare, and they need different treatment. If your doctor can’t remove the whole tumor, you may need to take medicine to prevent low blood sugar. You may also need chemotherapy. Depending on the type of tumor you have, another treatment is getting a radioactive medicine called lutetium Lu 177 dotatate (Lutathera). You get this medicine through an IV. This drug attaches itself to part of the tumor cell, and the radiation from the drug damages the cell. Most of the time, surgery will cure an insulinoma. There could be side effects or complications after surgery, including: If your insulinoma is cancerous, complications may include: